This invention relates to therapy devices, and in particular to devices that enable persons with upper extremity dysfunction""s to exercise upper body parts such as hands and arms through rehabilitation and reeducation exercises.
An increasing percentage of the United States population suffers from motor planning dysfunction""s and abnormal muscle tones as a result of various etiologies such as but not limited to Cerebral Vascular Accidents(CVA), head injuries and cerebral palsy. For example, there are approximately 500,000 new victims of Cerebral Vascular Accidents(CVA) annually in the United States. Additionally, at any given time there are two million persons who have survived strokes. Approximately seventy five percent of these affected persons will be rehabilitated to some degree of independence. Approximately sixty to seventy percent of these individuals can expect to become ambulatory. However, only approximately thirty to forty percent are expected to regain significant functional return of the affected upper extremity. See Zoltan et al, The Adult Stroke Patient, The Adult Stoke Patient, 2nd Edition, New Jersey, Slack Inc., pages iv, 53, 179. Clearly, there is a need to improve the rehab success rates for post-stroke patients that are increasingly becoming a larger part of the U.S. population.
One of the most devastating effects of stroke cases are their economic impacts. The annual cost of strokes in the United States is approximately thirty billion dollars! This includes approximately seventeen billion in direct medical costs and approximately thirteen billion in loss of productivity. See Newborn, Barbara, Return to Ithacca, USA, Element Books Unlimited, 1997, pages 98-99. As a nation, the United States is putting a great deal of money toward relatively unsuccessful rehabilitation systems without ever questioning how these systems can be improved.
Key stumbling blocks exist for stroke rehabilitation that are being overlooked during actual rehabilitation treatments due to the fact that there are no particularly effective methods available that can take place during the limited treatment times available. For instance, treatment is generally focused on the physical recovery and not toward the underlying sensory issues that are necessary components of motor functions. For example, xe2x80x9cthe body scheme is one of the essential elements involved in purposeful motor behavior.xe2x80x9d See MacDonald, J., An Investigation of Body Scheme In Adults With Cerebral Vascular Accident, American Journal Of Occupational Therapy, 1960, pages 75-79. By definition, a body scheme covers xe2x80x9ca postural model one has of himself, having to do with how one perceives the position of the body and the relationship of body parts. It is believed to be the basis of all movement . . . xe2x80x9d See Zoltan et al, The Adult Stroke Patient, The Adult Stoke Patient, 2nd Edition, New Jersey, Slack Inc., pages iv, 53, 179.
It is a fact that the patient must be able to orient themselves to the relationship of their body parts to one another to create purposeful movement. It has also been a proven result of research studies that body scheme disorders were typical of CVA patients irrespective of whether the patient has right or left hemisphere damage. See MacDonald, J., An Investigation of Body Scheme In Adults With Cerebral Vascular Accident, American Journal Of Occupational Therapy, 1960, pages 75-79. This being the case, body scheme disorders need to be aggressively targeted as a part of treatment before functional motor recovery can be expected to return.
Another often overlooked key to motor recovery is the importance of receiving accurate sensory input on a consistent activity-related basis. Without this input, the body is not provided adequate information to interpret in order for accurate motor output to occur in this afferent-efferent system.
Studies have proven the following about the importance of sensation to overall upper extremity functioning: (1) sensation is critical to movement; (2) without sensation a limb becomes essentially useless; (3) preservation of cutaneous sensation in the hand is indispensable for motor function of the upper limb; and (4) movements of the upper limb, particularly grasp function, are directed by contractual stimuli. See Padretti and Zoltan, Occupational Therapy Practice Skills For Physical Dysfunction, 3rd edition, St. Louis, C. V. Mosby Co., 1990, page 335.
The information from the hand guides the fingers around objects for grasp. Alternatively, information from the hand guides the movement of an object in the hand. Sensory information is crucial for precise movements. The fingers and thumb need tactile information to learn how to move the fingers and thumb together, and how to move the fingers and thumb independent from one another. Gripping and grasping manipulations are also dictated by tactile information entering the central nervous system and being transferred to the hand musculature. Once the hand grips and grasps the object, the tactile system is the dominant force in developing the grip and the grasp manipulations. Information from the tactile system is needed to regulate the force of the grasp and to control the slippage of objects. Therefore, any period of time that the hemiplegic side is not incorporated into daily activities, the body is deprived of essential input needed to interpret the environment in order to form an appropriate motor response. Feedback on the success of the movement is provided by effectiveness of task completion, which is required to reinforce this closed system response.
Various techniques have been proposed over the years that could be useful for rehabilitation and reeducation exercises. See for example, U.S. Pat. No.: 835,968 to Mennes; U.S. Pat. No. 3,604,307 to Vono; U.S. Pat. No. 3,655,185 to Kane; U.S. Pat. No. 3,747,593 to Taylor; U.S. Pat. No. 4,220,334 to Kanamoto et al.; U.S. Pat. No. 4,858,912 to Boyd; U.S. Pat. No. 4,960,114 to Dale; U.S. Pat. No. 5,141,478 to Upper; U.S. Pat. No. 5,191,903 to Donohue; U.S. Pat. No. 5,447,490 to Fula et al.; U.S. Pat. No. 5,711,747 to Steinback; U.S. Pat. No. 5,759,165 to Malewicz; U.S. Pat. No. 5,769,758 to Sarkinen; and U.S. Pat. No. 5,800,561 to Rodriguez. However, none of these devices provide an adequate therapeutic tool that allows for controlled hand over hand assistance that would be required for neuralgic retraining of the hemiplegic extremity.
The first objective of the present invention is to provide a modality to allow one person to practice upper body therapeutic exercises and activities to another person using controlled hand over hand assistance.
The second object of this invention is to provide a grasp assistance device to allow a single person to practice upper body neural muscular rehabilitation and reeducation exercises.
The third object of this invention is to provide therapy safety harness devices to provide safety and to decrease a patients fear of falling while providing hand over hand while doing upper body neural muscular rehabilitation and reeducation exercises to another person""s upper body.
A first preferred embodiment of the invention is for a hand over hand assistance glove where a palm surface of a therapist""s hand lays in symmetry on top of the dorsum portion of the patient""s affected hand. For example, the right hand of the therapist on the right hand of the patient, and the left hand of the therapist on the left hand of the patient. The therapist wears a glove having one inch by six inch strips of adhesive material extending from the sides of each finger and thumb to securely wrap around the patient""s fingers. Once the device is in place, the therapist can guide the patient through movement patterns. The therapist""s hand movements can control the paitient""s hand movements including reach, gross/refined grasp, fine pinch, in-hand manipulations, opposition type movements, functional object manipulations, and the like, to perform functional motor activities while allowing the patient to receive real and not simulated, sensory input to the hand.
A second preferred embodiment is a grasp assistance glove that allows patients to maintain a functional grasp for assisted activities and positioning. The patient can independently perform various exercises as well as positioning their affected upper extremity in edema controlling/anti-synergy positions. The palmer side of the glove can be covered with hook and loop(Velcro(copyright)) type fasteners, with four inch long straps extending from each finger and thumb. The patient""s lingers wrap about the object to be grasped(such as a bar) by attaching the fasteners extending outward from the fingers of the glove to the mating fasteners at the wrist area of the glove. The thumb straps wraps around to affix to hook and loop fasteners on backs of fingers.
The third embodiment includes a therapy harness that is used to increase safety and to decrease patient fear of falling while performing standing activities. As fear of falling has been noted to increase muscle tone, this will not only provide a safer therapy session but also help normalize movements to get the maximum benefit of treatment. This embodiment will allow the therapist/aide to perform activities with the first embodiment hand over hand assistance glove without compromising safety. The belt harness allows the therapist/aide to use their own body to support the patient safely if balance and stability is compromised. The therapist wears a harness belt that can be made of a heavy canvass material with a sturdy metal type tooth clasp which securely affixes to an identical adjoining belt of the same material with an extra strap to be worn between the patient""s legs for harness style support. Alternatively, the harness can be secured to a stationary object such as a support pillar, a door, and the like.
Further objects and advantages of this invention will be apparent from the following detailed description of a presently preferred embodiment which is illustrated schematically in the accompanying drawings.